Evaluating an Evidence-Based Intervention for Families and Survivors after Traumatic Brain Injury: The Brain Injury Family Intervention

Abstract

The long-term detrimental impact of traumatic brain injury (TBI) on individuals and their family members is well known. However, there have been few standardized family interventions or findings from treatment efficacy studies to guide clinical practice. The Brain Injury Family Intervention (BIFI) is an evidence-based, five-session, manualized clinical intervention, provided for both family members and the injured person. Guided by cognitive behavioral theory, the program provides education, skill building, and psychological support for both persons with brain injury and their family members. The objective of the present study was to test the efficacy of the BIFI as it was designed to improve the emotional well-being and life quality of persons with brain injury and their family members. Evaluation occurred in an outpatient neuropsychology department attached to a major academic medical center, with a sample of 53 family member caregivers of 53 TBI survivors. It was hypothesized that the BIFI would increase the proportion of caregivers' met needs, decrease their psychological distress, increase their perception that survivors' neurological functioning had improved, and reduce perceived obstacles to obtaining services. It also was hypothesized that the BIFI would result in improved neurological functioning for survivors. A secondary analysis of existing data using repeated measures mixed models was used to analyze four self-report measures for family members: (1) the Family Needs Questionnaire (FNQ); (2) the Service Obstacles Scale (SOS); (3) the Brief Symptom Inventory-18 (BSI-18); and (4) the Neurological Functioning Inventory (NFI). Survivors' neurological functioning was examined based on their own self-report data, also measured by the NFI. Data were collected at pre-treatment, immediate post-treatment and at a three-month follow-up after treatment. Statistical analyses revealed that, after participating in the BIFI program, caregivers reported significantly more met family needs, perceived fewer obstacles to receiving services, and rated the survivor as having reduced depression and somatic symptoms. No significant effects were observed for caregiver psychological distress or survivors' reports of their neurological functioning. Methodological limitations, implications for clinical intervention with families after TBI, and suggestions for future research are discussed.